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Background: Fatigue is common among patients with inflammatory bowel diseases (IBDs) and is associated with decreased quality of life (QoL)., Aims: Describe fatigue evolution and identify factors associated with fatigue outcomes in patients with ulcerative colitis (UC) or Crohn's disease (CD) initiating biologic treatment., Methods: Data from adult Belgian patients with UC or CD enrolled in a prospective real-world study were utilized. Fatigue and QoL were assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and the Short Inflammatory Bowel Disease Questionnaire, respectively. Factors associated with fatigue outcomes were assessed using multivariate regression., Results: 465 patients were included: 174 with UC and 291 with CD. Average FACIT-F scores indicated improvements in fatigue after 6 months, before stabilizing. A higher probability of fatigue disappearance was associated with clinical remission and was more likely in patients with UC than CD. Patients achieving clinical remission had lower probability of fatigue. Patients with fatigue improvements experienced greater QoL improvements than patients with fatigue persistence., Conclusions: Real-world findings suggest fatigue partly improves in the first 6 months of biologic treatment. Clinical remission was associated with greater probability of fatigue disappearance and lower likelihood of fatigue persistence. Further research into factors associated with fatigue in patients with IBD is warranted., Competing Interests: Conflict of interest E.L. reports educational and research grants from AbbVie, Fresenius Kabi, Janssen, Pfizer, and Takeda; speaker fees from AbbVie, Bristol Myers Squibb, Celgene, Dr Falk, Ferring, Galapagos, Janssen, Pfizer, and Takeda; serving on advisory boards for AbbVie, Arena, Bristol Myers Squibb, Celgene, Eli Lilly, Ferring, Gilead-Galapagos, Janssen, Pfizer, and Takeda; and being a consultant for AbbVie. P.B. reports research grants from AbbVie, Amgen, Celltrion, Mylan, Pfizer, and Takeda; lecture fees from AbbVie, Celltrion, Eli Lilly, Janssen, and Takeda; and consulting fees from AbbVie, Arena, Bristol Myers Squibb, Celltrion, Dr Falk, Eli Lilly, Galapagos, Janssen, Pentax, PSI-CRO, Roche, Takeda, and Tetrameros. A.C. reports consultancy fees from AbbVie, Galapagos, Janssen, and Takeda; and speaker fees from AbbVie, Celltrion, Galapagos, Janssen, and Pfizer. S.V. reports grants from AbbVie, Galapagos, Johnson & Johnson, Pfizer, and Takeda; and consulting and/or speaker fees from AbbVie, AbolerIS, AgomAb, Alimentiv, Arena, AstraZeneca, Avaxia, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, CVasThera, Cytoki, Dr Falk, Eli Lilly, Ferring, Galapagos, Genentech-Roche, Gilead, GSK, Hospira, Imidomics, Janssen, Johnson & Johnson, Materia Prima, Merck Sharp & Dohme, MiroBio, Morphic, MrMHealth, Mundipharma, Pfizer, Prodigest, Progenity, Prometheus, Robarts Clinical Trials, Second Genome, Shire, Surrozen, Takeda, Theravance, Tillots, and Zealand. V.S. reports receiving a research grant from Takeda. F.B. reports grant/research support from AbbVie, Amgen, Janssen, and Takeda; being a speaker for AbbVie, Celltrion, Ferring Holding SA, Janssen, Merck Sharp & Dohme, Pfizer, and Takeda; honoraria from AbbVie, Amgen, Arena, Celltrion, Ferring Holding SA, Fresenius Kabi AG, Galapagos, Janssen, Merck Sharp & Dohme, Pfizer, and Takeda. F.F. reports research grants from Takeda. A.H. and G.V.G. are employees of Takeda. J.Z. is an employee of and holds stock/stock options in Takeda. The other authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The natural history of ulcerative colitis (UC) is unpredictable. Factors associated with the need for different types of step-up therapy in UC patients failing on 5-aminosalicylic acid (5-ASA) or corticosteroids are understudied., Aims: Describe step-up therapy in patients with UC the first year after failing on 5-ASA or corticosteroids., Methods: A Belgian, multi-center, prospective, non-interventional observational study comprising adult UC patients failing on 5-ASA or corticosteroids and naïve to immunomodulators/ biologicals. During a 12 months follow-up, patient characteristics, demography, medical therapy, biomarkers, therapy adherence and quality of life (QoL) were assessed., Results: After 1 year, 35% of the patients were on biological therapy. Use of anti-TNF differed depending on baseline treatment: corticosteroid-refractory patients (55.8%), 5-ASA refractory (20.0%), and corticosteroid-dependent (16.0%) patients (p<0.001). The decision to start a line of therapy was based on the Mayo combined severity but not on biomarkers like faecal calprotectin, haemoglobin, CRP, albumin, platelets, and number of extraintestinal manifestations. At year 1, 84.2% of the patients had only mild UC or remission and a significant improvement of fatigue (p=0.004) and IBDQ scores (p<0.001) were observed implying an improved QoL., Conclusion: Treatment step-up, based on clinical scores in immunomodulatory and anti-TNF naïve patients with UC, provides good clinical outcomes and QoL., (© Acta Gastro-Enterologica Belgica.)

This is a case report of a patient with a thoracic aortic aneurysm (TAA) presenting with dysphagia and weight loss as primary symptoms. She was treated via thoracic endovascular aortic repair (TEVAR). The procedure was complicated with a secondary aortoesophageal fistula (AEF) for which open surgical repair of the esophageal defect was done. Long term (i.e. more than 30 days) antibiotics were given. The recovery was uneventful., (© Acta Gastro-Enterologica Belgica.)

We present a case of a 64-year old woman who developed acute kidney injury (AKI) finally resulting in stage 4 chronic kidney disease after ingestion of a high phosphate containing solution (oral Fleet Phospho Soda) as bowel cleansing for colonoscopy.

As population-wide screening for colorectal cancer is adopted by many western countries for all individuals aged 50-75. The success of screening colonoscopy programs is highly dependent on the quality of the procedures. High-quality complete endoscopy with excellent patient preparation and adequate withdrawal time is necessary for effectively reducing colon cancer risk. In Belgium formal quality assurance programs and principles of credentialing do not exist. The current reimbursement system for colonoscopy does not reward a careful performed examination but rapidly performed examinations at unnecessarily short intervals. There is a clear need for evidence-based quality measures to ensure the quality of screening colonoscopy. In this guideline review we present an overview of the literature concerning criteria for best practice and important quality indicators for colonoscopy. A summary of the latest guidelines is given. Our goal of this update is to provide practical guidelines for endoscopists performing screening colonoscopy. We hope to provide a broad consensus and an increasing adherence to these recommendations.

We report on a case of recurrent superior mesenteric artery (SMA) stenosis with symptomatic mesenteric angina after SMA angioplasty. Stent placement of postostial atherosclerotic disease was proposed, with successful result. Moderate aortic protrusion was noted. Feasibility of PTA and stenting of mesenteric stenoses become increasingly obvious, but long term follow-up studies still have to provide sufficient results on clinical outcome and possible complications.

An endoscopical and histological study was carried out in 114 patients, treated by 'curative' resection of the terminal ileum and part of the colon for Crohn's disease, in order to study the natural history of recurrent Crohn's disease. The recurrence rate of Crohn's disease in patients examined within one year of the operation was 72%. This figure did not differ significantly from that in patients examined one to three years or three to 10 years after surgery (79% and 77% respectively). Recurrence was located in the neoterminal ileum and at the anastomosis in 88% of the patients. Early endoscopic signs of recurrence were small aphthous ulcers in the neoterminal ileum. Ileal biopsies at this stage showed an important inflammatory cell infiltrate of the lamina propria with numerous eosinophils and fusion and blunting of the villi. More advanced lesions observed in patients examined one to three years after surgery, consisted of larger, often serpiginous ulcerations and nodular thickening of folds. In patients examined three to 10 years after the operation, the anastomosis was frequently stenosed and rigid, with large ulcers extending from the stenosis into the colon. Mucosal granulomas may be found in normal appearing mucosa as well as in the obviously inflamed mucosa surrounding the ulcers. These studies suggest that recurrence of Crohn's disease almost always develops in the first year after the operation. Significant endoscopic lesions may be present without clinical symptoms, particularly in the earlier stages of the disease.

The efficacy and safety of omeprazole, 40 mg once daily for four to eight weeks of treatment, were studied in 61 patients with ulcerative reflux esophagitis. A double-blind controlled study design was used, and the patients were randomly allocated to treatment with either omeprazole 40 mg once daily or ranitidine 150 mg twice daily. Endoscopy was performed prior to inclusion into the study, after four weeks and, if unhealed, again after eight weeks. Healing of esophagitis was defined as complete disappearance of all esophageal ulcerations. Symptoms were recorded before entry, after four weeks, and again after eight weeks in unhealed patients. Fifty-one patients were included in the per-protocol analysis at day 29, and 50 patients at day 57. The healing rate after four weeks of treatment was 22 of 26 patients (85%) treated with omeprazole and 10 of 25 patients (40%) treated with ranitidine (P less than 0.001). The corresponding figures after eight weeks were 24 of 25 (96%), and 13 of 25 (52%) (P less than 0.001). These results were confirmed in the intent-to-treat analysis. Patients treated with omeprazole showed a significantly faster and more profound relief in heartburn than patients treated with ranitidine: 85% had no heartburn after four weeks of treatment with omeprazole compared to 24% in patients treated with ranitidine (P = 0.00007). The percentage of patients who were free of all reflux symptoms was significantly greater in the omeprazole-treated group as compared to the ranitidine-treated group (62% and 12% respectively; P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

A patient is described who showed signs of eclampsia in the 31st week of first pregnancy. The cause of shock proved to be a subcapsular hematoma in the liver and it was accompanied by a hematothorax. The diagnosis was made by CT-scanning. The pathogenesis is discussed.